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Recommendations

VTE Prophylaxis. Recommendations. Risk. Recommendation. Low (0-1). Ambulation (all pts). IPC/GCS or, UFH 5000 SQ q 12 hrs or, Enoxaparin 40mg SQ daily. Moderate (2-3). IPC/GCS plus… UFH 5000 SQ q 8 hrs Enoxaparin 40mg SQ daily Enoxaparin 30mg SQ q 12 hrs. High (4-5). IPC/GCS plus…

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Recommendations

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  1. VTE Prophylaxis Recommendations Risk Recommendation Low (0-1) Ambulation (all pts) IPC/GCS or, UFH 5000 SQ q 12 hrs or, Enoxaparin 40mg SQ daily Moderate (2-3) IPC/GCS plus… UFH 5000 SQ q 8 hrs Enoxaparin 40mg SQ daily Enoxaparin 30mg SQ q 12 hrs High (4-5) IPC/GCS plus… UFH 5000U SQ q 8 hrs; or Enoxaparin 40 mg SQ daily or Enoxaparin 30mg SQ q 12 hrs Fondaparinux 2.5 mg SQ daily Highest (>6)

  2. VTE Prophylaxis Recommendations Risk Recommendation Low (0-1) Ambulation (all pts) IPC/GCS or, UFH 5000 SQ q 12 hrs or, Enoxaparin 40mg SQ daily Moderate (2-3) IPC/GCS plus… UFH 5000 SQ q 8 hrs Enoxaparin 40mg SQ daily Enoxaparin 30mg SQ q 12 hrs High (4-5) IPC/GCS plus… UFH 5000U SQ q 8 hrs; or Enoxaparin 40 mg SQ daily or Enoxaparin 30mg SQ q 12 hrs Fondaparinux 2.5 mg SQ daily Highest (>6)

  3. VTE Prophylaxis Recommendations Risk Recommendation Low (0-1) Ambulation (all pts) IPC/GCS or, UFH 5000 SQ q 12 hrs or, Enoxaparin 40mg SQ daily Moderate (2-3) IPC/GCS plus… UFH 5000 SQ q 8 hrs Enoxaparin 40mg SQ daily Enoxaparin 30mg SQ q 12 hrs High (4-5) IPC/GCS plus… UFH 5000U SQ q 8 hrs; or Enoxaparin 40 mg SQ daily or Enoxaparin 30mg SQ q 12 hrs Fondaparinux 2.5 mg SQ daily Highest (>6)

  4. VTE Prophylaxis Specific Recommendations • General surgery • Vascular surgery • Gynecologic surgery • Urologic surgery • Laparoscopic surgery • Orthopedic surgery • Neurosurgery • Trauma • Burns • Medical patients • Cancer patients • Critical care

  5. Venous Thromboembolism Diagnosis • Deep vein thrombosis • Pulmonary embolism

  6. Venous Duplex Acute DVT

  7. Venous Duplex Acute DVT

  8. Acute DVT: Diagnosis D-Dimer Predictive Values Clinical Probability Positive Negative Overall 23.5% 96.1% High 38.6% 89.0% Low 14.1% 99.1% D-Dimer negative predictive values equal to venous duplex over 3 mos follow-up Wells PS, et al NEJM 2003;349:1227-35

  9. Use of D-Dimer in the Diagnosis of DVT DVT Clinically Unlikely D-Dimer Test Positive Negative Ultrasound DVT excluded (99% NPV) Positive Negative Treat Repeat ultrasound in 3-7 days Modified from: Wells PS et al NEJM 2003;349:1227

  10. Use of D-Dimer in the Diagnosis of DVT DVT Clinically Likely Venous Duplex Positive Negative Treat DVT D-Dimer Negative Positive Repeat venous duplex 3-7 days DVT excluded Modified from: Wells PS et al NEJM 2003;349:1227

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